1684: At a Crossroad: Understanding the Impact of a Palliative Care Consult After a Rapid Response Event

Introduction: Rapid response teams (RRT) have become common place in the United States (US). Thus far, research on their use has primarily identified the role of RRT in reducing mortality from cardiac arrest. Given the high mortality of this patient population, we seek to review the impact of palliative care consultation following rapid response events. Methods: We performed a retrospective review of patients admitted to medical, cardiac, oncology, and observation units at a single academic medical center who had a rapid response (RR) event between March 1 and August 31, 2024. Data collected included patient demographics, palliative care consultation, hospital length of stay, patient in-hospital and mortality, and level of care received prior to mortality. Chi-square and t-testing were utilized with statistical significance set at a p value of 0.05. Results: There were 903 RR activations on 620 unique patients during the study period. Overall, in-hospital mortality was 31.9% (198/620). While admitted, palliative care was consulted in 21.6% (134/620) of cases and 41.9% (83/198) of cases with in-hospital mortality. The average time from RR event to palliative consultation was 8 days. Mortality among patients with palliative consultation was 61.0% vs 23.8% (p< 0.001). Among patients who died, 13.1% (26/198) received CPR, 43.4% (86/198) died after ICU escalation without CPR, and 43.4% (86/198) were transitioned to comfort-focused care without receiving invasive therapies. Palliative care involvement was associated with a significant decrease in patients receiving CPR and an increase in dying with comfort measures only (p< 0.001). Oncology patients were more likely to have a palliative care consult (p< 0.0001) but received a similar level of aggressive interventions prior to death (p=0.166). Length of stay was longer for patients with a palliative care consult (29.4 vs 21.5 days, p=0.003). Conclusions: Palliative care involvement is associated with a decrease in invasive care received by patients prior to death following RR events. Overall, palliative care involvement is underutilized in patients that undergo clinical decompensation. Further research is needed to understand the impact of the timing of palliative care involvement on utilization of invasive interventions and providing goal concordant care.